Fjellestad-Paulsen A, Abrahamsson P A, Bjartell A, Grino M, Grimelius L, Hedeland H, Falkmer S
Department of Endocrinology, Lund University, Malmö General Hospital, Sweden.
Acta Endocrinol (Copenh). 1988 Dec;119(4):506-16.
A case is described of a patient with a small-cell prostatic carcinoma containing immunoreactive CRH, in conjunction with ACTH-dependent Cushing's syndrome. The serum concentrations of CRH, ACTH, beta-endorphin and calcitonin were all found to be above normal. Post-mortem examination revealed a prostatic tumour with multiple metastases, and a diffuse hyperplasia of pituitary corticotropic cells and adrenal cortical cells. In sections of the primary prostatic tumour, immunoreactive cells were demonstrable with antisera raised against human CRH, TSH, calcitonin and somatostatin, but not with antisera against ACTH or beta-endorphin. By radioimmunoassay the CRH-like material could also be demonstrated in extract of the prostatic tumour and the material from both plasma and tumour extract eluted at the position of human CRH on gel chromatography (Sephadex G-75). These findings provide support for the interpretation that the patient's Cushing's syndrome was due to a CRH-producing prostatic tumour. Finally, the origin and the clinical significance of the neuroendocrine cells in the prostatic carcinoma is discussed.
本文描述了一例患有小细胞前列腺癌并伴有免疫反应性促肾上腺皮质激素释放激素（CRH），且并发促肾上腺皮质激素（ACTH）依赖型库欣综合征的患者。研究发现，患者血清中CRH、ACTH、β-内啡肽和降钙素的浓度均高于正常水平。尸检显示前列腺肿瘤伴有多处转移，垂体促肾上腺皮质激素细胞和肾上腺皮质细胞呈弥漫性增生。在原发性前列腺肿瘤切片中，用针对人CRH、促甲状腺激素（TSH）、降钙素和生长抑素的抗血清可检测到免疫反应性细胞，但用针对ACTH或β-内啡肽的抗血清则检测不到。通过放射免疫分析，在前列腺肿瘤提取物中也可检测到CRH样物质，并且血浆和肿瘤提取物中的物质在凝胶过滤色谱法（Sephadex G - 75）上与人CRH处于相同洗脱位置。这些发现支持了该患者库欣综合征是由产生CRH的前列腺肿瘤所致的解释。最后，本文讨论了前列腺癌中神经内分泌细胞的起源及其临床意义。
